Healthcare Provider Details

I. General information

NPI: 1770637365
Provider Name (Legal Business Name): PAUL ANTHONY TENETTE RPN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DELTA DRUGS

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DELTA DRUGS 1666 N MEDICAL CENTER DRIVE
SAN BERNADINO CA
92411
US

IV. Provider business mailing address

DELTA DRUGS 1666 N MEDICAL CENTER DRIVE
SAN BERNADINO CA
92411
US

V. Phone/Fax

Practice location:
  • Phone: 909-887-2596
  • Fax: 909-887-8496
Mailing address:
  • Phone: 909-887-2596
  • Fax: 909-887-8496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number37618
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: